A Paradigm to Examine Cancer Disparities: Limited English Proficient Chinese Patients with Thyroid Nodules

检查癌症差异的范例：英语水平有限的中国甲状腺结节患者

• 批准号: 10661137
• 负责人: Debbie Wan Hua Chen
• 金额: $ 18.25万
• 依托单位: UNIVERSITY OF MICHIGAN AT ANN ARBOR
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-08-09 至 2028-07-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10661137
• 关键词: Address; Administrator; Area; Asian; Asian Americans; Asian population; California; Cancer Patient; Caring; Cause of Death; Cessation of life; Chinese; Chinese American; Chinese population; Clinical Trials; Cohort Studies; Communication; Continuity of Patient Care; Data; Decision Making; Detection; Development; Diagnosis; Disparity; Effectiveness of Interventions; English Language; Equity; Ethnic Origin; Ethnic Population; Evaluation; Fine needle aspiration biopsy; Focus Groups; Funding; Goals; Health Personnel; Health Services; Individual; Information Resources; International; Intervention; K-Series Research Career Programs; Language; Learning; Limited English Proficiency; Linguistics; Link; Literature; Malignant Neoplasms; Malignant neoplasm of thyroid; Medical; Mentors; Michigan; Modeling; Nodule; Outcome; Pacific Islander; Patient Recruitments; Patient Self-Report; Patients; Physicians; Pilot Projects; Policy Maker; Population; Preparation; Public Health; Quality of Care; Race; Reporting; Research; Research Personnel; Research Proposals; Resources; Sampling; San Francisco; Site; Surgical complication; Surveys; Thyroid Gland; Thyroid Nodule; Training; United States; Universities; Variant; Woman; Work; acceptability and feasibility; advanced disease; arm; barrier to care; burden of illness; cancer care; cancer diagnosis; cancer health disparity; cancer therapy; care delivery; design; ethnic minority population; experience; improved; innovation; mortality; nonEnglish language; patient population; prototype; racial population; recruit; sex; skill acquisition; therapy development; tool; virtual

PROJECT SUMMARY Asian Americans and Pacific Islanders are the only racial/ethnic group in the United States (US) for whom cancer is the leading cause of death for both sexes. Thus, there is an urgent need for research focused on understanding the mechanisms by which cancer disparities occur in this vulnerable patient population. Across the thyroid cancer care continuum, which starts prior to diagnosis and treatment of cancer, Asians experience a disproportionate burden of disease and death. Among Asian women, in particular, thyroid cancer is the second most common cancer and thyroid cancer mortality is the highest of any racial/ethnic group in the US. Differential management of thyroid nodules, a precursor of thyroid cancer, likely contributes to observed downstream disparities in the thyroid cancer continuum. However, Asians continue to be underrepresented in both the cancer disparities and thyroid literature, potentially exacerbated by the high rates of limited English proficiency in this population. Thus, granular data on the quality of medical care received by Asian Americans across the thyroid cancer care continuum is lacking. We propose using the paradigm of limited English proficient (LEP) Chinese patients with thyroid nodules to improve our understanding of linguistic disparities across the thyroid cancer care continuum and to inform the development of interventions that promote equitable care for LEP patients. In Aim 1, we will survey a national sample of physicians to examine variation in medical care delivery to LEP patients with thyroid nodules and thyroid cancer. In Aim 2, we will recruit patients from two sites, the University of Michigan (U-M) and the University of California, San Francisco (UCSF), to conduct virtual focus groups of LEP and English- proficient Chinese patients with thyroid nodules to explore their experiences with thyroid nodule evaluation and treatment. In Aim 3, we will use study findings from Aims 1 and 2 to inform the development and evaluation of a thyroid nodule decision preparation tool prototype for LEP Chinese patients. Data from the subsequent pilot clinical trial to evaluate the feasibility, acceptability, and preliminary effectiveness of this intervention will inform a R01 application to develop and evaluate a more comprehensive, multilevel, personalized thyroid nodule decision preparation tool that is accessible in multiple languages. By tailoring this intervention to the LEP patient population and targeting disparities more upstream of the cancer continuum, we hope to improve downstream cancer outcomes for LEP patients with thyroid cancer. This innovative research proposal fulfills a critically important unmet public health need while serving as a vehicle for Dr. Debbie Chen’s development into an independent health services researcher in the fields of cancer disparities and thyroidology. In addition to didactic learning, she will receive mentoring from her team of committed mentors and advisors who have complementary expertise and are internationally recognized experts in their field. Upon completion of this carefully designed project linking skill acquisition to research aims, Dr. Chen will emerge as an expert in linguistic disparities across the cancer care continuum.

项目摘要 亚裔美国人和太平洋岛民是美国唯一的种族/种族群体（美国） 是两性死亡的主要原因。这是迫切需要研究的研究 癌症差异在这个脆弱的患者人群中发生的机制。跨甲状腺癌 在诊断和治疗癌症之前开始的护理连续体经历了不成比例的 疾病和死亡负担。在亚洲妇女中，尤其是甲状腺癌是第二常见的 癌症和甲状腺癌死亡率是美国任何种族/族裔中最高的。差异管理 甲状腺癌的前体甲状腺结节可能有助于观察到的下游分布 甲状腺癌仍在继续。但是，亚洲人在癌症分布和 甲状腺文献可能会因该人群的英语水平有限而加剧。那， 关于亚裔美国人在甲状腺癌症护理中接受的医疗质量的粒状数据 缺乏连续体。我们建议使用有限英语熟练（LEP）的中国患者的范式 甲状腺结节，以提高我们对甲状腺癌症护理连续性语言差异的理解 并告知开发为LEP患者促进公平护理的干预措施。在AIM 1中，我们将 调查全国医师样本，以检查甲状腺LEP患者的医疗服务差异 结节和甲状腺癌。在AIM 2中，我们将招募来自密歇根大学（U-M）两个地点的患者 加利福尼亚大学旧金山大学（UCSF）进行虚拟焦点小组的LEP和英语 - 专业的甲状腺结节患者，探索他们接受甲状腺结节评估的经历和 治疗。在AIM 3中，我们将使用AIM 1和2的研究结果来告知 甲状腺结节决策制备工具针对LEP中国患者的原型。随后的飞行员的数据 评估此干预措施的可行性，可接受性和初步效果的临床试验将告知 R01的应用程序，用于开发和评估更全面，多级，个性化的甲状腺结节 决策准备工具，可使用多种语言访问。通过对LEP患者的这种干预量调整这种干预 人口和针对分布的癌症连续性更高的分布，我们希望改善下游 LEP患者患有甲状腺癌的癌症结局。这项创新的研究提案实现了批判性的 重要的未满足的公共卫生需求，在作为Debbie Chen博士开发的工具中 癌症分布和甲状腺学领域的独立卫生服务研究员。除了教学 学习，她将收到拥有完整的忠实导师和顾问团队的指导 专业知识，是其领域的国际知名专家。完成此精心设计的 链接技能获取与研究目标的项目，陈博士将成为各个方面的语言差异的专家 癌症护理连续性。